The CDC estimates a $124 billion aggregate lifetime economic burden incurred by victims of child maltreatment. A large literature supports positive associations between child maltreatment and adverse physical health outcomes including cardiovascular disease, obesity, diabetes, lung cancer, chronic pain, headaches, sexually-transmitted infections, and autoimmune diseases. However, the majority of these findings derive from cross-sectional, short-term, or adult retrospective study designs, severely limiting scientific credibility and causal inferences. Moreover, putative etiological processes leading to such outcomes remain largely unknown and not every child who has been maltreated will experience any long-term health effects, suggesting the presence of unique risk and resilience pathways. This lack of understanding in the basic mechanisms conferring risk or resilience for victims of child maltreatment has stymied translational research where preventative interventions targeting identified pathways can be developed or modified in an effort to reduce these health disparities and their corresponding healthcare costs. Project 1 will raise the rigor of this science and address critical gaps by implementing a large, prospective cohort study to examine the effects of child maltreatment on multiple etiological processes believed to play a role in the onset and maintenance of adverse health outcomes for victims. Through a large-scale partnership with the State of Pennsylvania's Department of Human Services, Project 1 will recruit a large cohort of 1200 children aged 8?13 (50% males), including 900 who experienced substantiated maltreatment within the past year (300 sexual abuse, 300 physical abuse, and 300 neglect), along with demographically matched control children (300). The processes of biological embedding (BE) at the neuroendocrine, autonomic, immunologic, epigenetic, and cellular (i.e., mitochondria and telomere biology) levels will be examined as mechanisms of child health, including brain health (i.e., optimal neurodevelopmental trajectories), behavioral & emotional health, and physical health. Psychosocial and behavioral processes such as resilience (i.e., school engagement, self-esteem, family and peer support, adaptive coping, flexibility, cognitive ability, emotion regulation, and executive functioning); healthy lifestyle behaviors (i.e., exercise, sleep, diet, sexual attitudes, and substance use); and treatment utilization will be examined as plausible malleable factors that mitigate the relationship between BE and health. Aims include: (Aim 1) a comprehensive understanding of the interplay among child maltreatment, biological embedding (BE), and health status; (Aim 2) testing how BE operates independently and in conjunction with psychosocial and behavioral factors to explain the relationship between maltreatment and health status; and (Aim 3) testing the moderating effects of genotype, gender, ethnicity, pubertal stage, and maltreatment type on models tested in Aims 1 & 2.